Urinary Incontinence

Impairments of urination in women include:

• Impairments of urine storage (involuntary urine leakage – such as “stress urinary incontinence” and “overactive bladder”)
• Impairments of emptying and of sensation (urgency, frequency, and pain).

Urinary Incontinence

Urinary incontinence is generally defined as “a complaint of any involuntary urine loss”. 5-10 percent of older women have severe urinary incontinence in their everyday lives, causing a dramatic and negative change in their quality of life. Many women in this group suffer deterioration in their self-confidence.

Urinary incontinence is an international phenomenon, and it is estimated that about one-third of adult women (over the age of 40) suffer from urinary incontinence at least once a week. In spite of the difficulty and the impairment in quality of life, many women avoid discussing and revealing these disorders. Some feel embarrassment or shame and suffer in silence; others do not bring the topic up due to the incorrect perception that treatment does is ineffective.

Even a tiny amount of urine leakage (a few drops…) can be felt by the woman to be seriously disconcerting. The extent to which the woman is bothered by this is influenced by many factors, such as cultural values, expectations, living environment and physical activity. Urinary incontinence can almost always be improved and even cured by simple means. Therefore, if the urinary incontinence is perceived by the woman as disturbing, an investigation can and should be performed, and treatment offered.

Types of urinary incontinence in women

The common types of urinary incontinence in women are:

• Stress urinary incontinence (in some 50% of women suffering from urinary incontinence).
• Urge incontinence (overactive bladder syndrome- in some 20% of sufferers).
• Mixed incontinence (stress urinary incontinence and symptoms of overactive bladder syndrome) occurring in combination with the same woman (some 30% of these women).

Urge incontinence: in older women

Even though stress urinary incontinence is the most common incontinence in women, urge incontinence (“overactive bladder syndrome”) is the most common type of urinary incontinence in older women and is defined as involuntary loss of urine that occurs together with or preceded by a sensation of urgency to urinate. Additionally, these women may experience increased frequency of urination during the day and at night. This problem is caused by uncontrolled contractions of the wall of the urinary bladder, usually for a poorly understood reason, constituting a manifestation of a defect of the neural control of the urinary bladder.

Modes of treatment of urinary incontinence

The treatment of involuntary leakage of urine in women may be conservative, or medicinal, and the therapeutic approach is based on the clinical findings and the degree of disturbance felt by the woman.

Simple conservative measures

It is possible to start with simple measures such as lifestyle changes. For example, setting fixed times for urinating, cutting down on caffeine consumption, quitting smoking and losing weight. A further simple measure is physiotherapy of the pelvic floor muscles, which can be offered as the first line of conservative treatment for women suffering from urinary incontinence.

Medicines that relax the muscular wall of the urinary bladder:

• First-line treatments – The most significant and basic treatment of the “overactive bladder syndrome” and of stress urinary incontinence is medicinal treatment using a group of medicines that relax the muscular wall of the urinary bladder, belonging to the anticholinergic family of medicines. These medicines block receptors in the muscular wall of the urinary bladder, thus reducing contractions and relieving symptoms of urgency, frequency and the need to urinate during the night. Medicinal treatment relieves symptoms at a rate of 60-80%.
• Second-line treatment – In the absence of improvement with medicinal treatments (first-line treatments), a Botox injection to the urinary bladder can be performed, with the help of direct observation of the urinary bladder, with or without anesthesia. This treatment has been found to be very effective.